An aging generation,
its joints wearing out,
finds a whole new way to 'get hip'
By Patricia Guthrie / Cox News Service
01-23-01

Age and arthritis caught up with David Polk one ordinary morning in his kitchen. One moment he was walking on two strong legs; the next, his right hip had frozen in place.

In an instant, he went from being a healthy, active, 47-year-old half-marathon runner and racquetball weekend warrior to a baby boomer destined for the bionic shop. He needed a new body part: a shiny, titanium fake hip.

"It was pretty devastating," recalls Polk, now 53. "I was running five miles a day, five days a week, and my hip just locked up on me. The joint and socket were rubbing bone on bone. I had no idea it was that bad until it showed up on the X-ray."

He loaded up on anti-inflammatory drugs for 18 months, but finally couldn't endure the pain. At Henry Medical Center in Stockbridge, Ga., he received a new right hip, made of titanium alloy and weighing about 1.5 pounds. Because he received an epidural -- medication that blocks pain but leaves the patient conscious -- he was able to watch as surgeons sawed through his femur and pelvic bone and "basically cut my leg off."

As drastic and dangerous as it sounds, Polk says, "It's the greatest thing I've ever done. I feel like a million bucks."

He is far from alone in his early entry into the arena of artificial joints. Or his satisfaction with one. Baby boomers -- those 76 million Americans born from 1946 to 1964 -- make up an ever-increasing proportion of patients receiving total hip or total knee joint replacements. While there's no data on the number of boomers going bionic, local orthopedic surgeons report that more and more people in their 40s and 50s are opting for the operation.

"Actually, it's unbelievable how many 50-year-olds I'm seeing," said Dr. Stephen Smith, of Peachtree Orthopaedic Clinic and the Reconstructive Joint Center of Atlanta at Piedmont Hospital.

And, as boomers age, more and more will look to high-tech solutions -- whether it's hip protheses, cartilage transplantation or, in the future, genetically engineered alternatives -- to keep them active as long as possible, predicted Dr. Stan Dysart of Pinnacle Orthopaedics & Sports Medicine Specialists, which has nine offices in metro Atlanta. "All you have to do is take a look at the demographics to see the impact," he said.

Currently, people 65 and older receive 65 percent of the 160,077 hip replacements done yearly, while nearly 75 percent of the 266,000 knee replacements go to those 65 and up. And, in just 10 years, the proportion of America's senior citizens will double, from 15 percent to 30 percent of the population. A coalition of doctors in 39 countries, who all expect to feel the increasing crunch of faltering and fractured body parts, has dubbed this the ''Decade of the Bone and Joint.''

The prime condition that leads to artificial joints is osteoarthritis, the arthritis that's caused by wear and tear and that is also known as degenerative joint disease. It causes the cartilage cushioning the bone to erode.

About 21 million Americans, most of them over 45, have osteoarthritis now, and 30 million may have it by 2020. The disease can range from mild to severe, affecting hands and weight-bearing joints: the knees, hips, feet and back. Many factors can play a part in osteoarthritis, including genetics, age, joint injuries suffered in sports, work or trauma, and too little exercise, because obesity strains joints.

Genetics is a strong factor. According to a recent National Institutes of Health report, genetics accounts for about half of osteoarthritis cases in hands and hips and a smaller percentage in knees.

But answering a patient's query as to why he or she has aching joints is never easy, doctors say. "We know joint injuries increase the rate of arthritis, but the most common reason we give is, 'We don't know,'Ê'' says Dysart.

Of course, baby boomers are an exercise-crazed group: the generation that wasn't satisfied just to jog, swim or hike, but had to prove its immortality by competing in marathons, triathlons and trail races up, down and across canyons, mountains and jungles. The generation that "vacations" by scaling walls in Yosemite and torpedoing down black double-diamond ski runs in Aspen, Colo.

Are hardware hips that set off airport security alarms the price they have to pay? Maybe so, some experts say.

"When the fitness craze began in the 1960s, no one was thinking about the orthopedic debt to be paid down the line," observes Bob Duvall, orthopedic physical therapist at Sports Medicine of Atlanta. "Sure, with the exercise we were improving our longevity, but there's a price to be paid in the quality of that longer life."

On one hand, exercise, particularly strengthening the quadriceps, the large muscles on the fronts of the thighs, helps offset osteoarthritis because it keeps joints from getting stiff. Weight-bearing exercise is also a prescription against osteoporosis, the disease of brittle bones that commonly afflicts older people.

But high-impact or repetitive-movement sports such as football, soccer, tennis, basketball and baseball can lead to being benched early by joint damage. And sports-related cartilage and bone injuries can mean unbearable pain 25 years down the line.

But the good news is that hip and knee replacement surgeries are regarded as safe and, in general, extremely successful. On average, a man-made hip can last 10 to 15 years, while a knee usually can give 10 to 20 years of mileage.

Dr. Robin de Andrade, who has been performing hip replacement surgery since its early days 30 years ago, regards it as one of the greatest medical advances of the last half-century. "In 90 percent of my patients, I can relieve 90 percent of their pain," says de Andrade the Emory physician said.

Risks include the standard risks of undergoing a major operation, and complications of infection, blood clotting and dislocation. Extraordinary measures are taken to minimize infection (surgeons wear "space suits," high-dose antibiotics are given intravenously and the operating room is equipped with a special filtration system), and the risk of infection is less than one-half of 1 percent. Blood clotting occurs about 5 percent of the time, while risk of the hip dislocating is about 2 percent.

Most health insurance plans cover the operation, which requires three to seven days in the hospital, followed by six to eight weeks rehabilitation. Complete recovery could take up to six months. Knee replacement physical therapy is more intensive then hip replacement because the knee is the biggest joint in the body.

Taking out diseased joints and inserting prosthesis with the help of saws, drills and reamers is done only after more conservative pain-relief measures have failed.

Ken Hagadorn got relief from the supplement glucosamine when his knee started hurting at age 46. But it did nothing to quell the mounting pain in his hips. After going through eight anti-inflammatory drugs, the tennis-playing, skiing, kayaking father of three checked into St. Joseph's Hospital last June and came out with two new hips.

"Within 10 days, I was climbing stairs in my house. I was driving again in 3 weeks," said Hagadorn, who's back on the road in his sales job.

Although, it may not exactly be on the advice of his surgeon, Dr. Ken Kress, Hagadorn is back on the court, the slopes, and the river. "First I told him I went out hitting tennis balls with my daughter. Then I told him I went up to the Nantahala River in August kayaking with my sons. Then, when I told him I planned to go skiing, he responded, 'Don't tell me before you go. Tell me when you get back.'

"Well, I went right after Christmas to Crested Butte in Colorado. It was like I never had a problem with my hips. It was great to know I could do it again."

Patients under age 50 can expect to need a second -- even third --set of parts, know as revision, or replacement, surgery, depending on their age and level of activity. While patients may golf, garden, dance, hike and swim with no problem, jogging and high-impact and contact sports are considered unwise. Bone loss and tissue quality lessen long-term success with each joint revision.

Thirty years ago, artificial hips starting failing after only two years. Currently being tested in U.S. clinical trials (including on legendary golfer Jack Nicholas) is a ceramic hip ball and socket that could prove to last as long as the patient. It's already widely used in Europe. Kress, of Resurgens Orthopaedics and chief of orthopedic surgery at St. Joseph's, has implanted this experimental hip in 90 local patients, including Hagadorn.

"Laboratory testing has shown having a ceramic ball against a ceramic liner wears 200 times better than the metal on plastic version," said Kress. "But we won't be able to say how long it will last in people until they wear it."

This longer shelf life of the prothesis is the other reason younger patients are receiving artificial hips and knees. People in their 30s sometimes need replacement surgery because of congenital diseases or medical treatment that's affected their joints.

Perhaps the greatest benefit of longer-lasting artificial hips and knees is for people whose original joints never worked. People like 25-year-old Kim Corbin, who hopes to soon straddle a bicycle for the first time. Juvenile rheumatoid arthritis robbed Corbin of almost all physical activity from age 3. In May, she received an artificial right hip, followed by two new knees last month.

"It's made an astonishing difference," the Dacula resident said. "I can walk up and down stairs now, and I'm pain-free. My rheumatologist wanted me to wait until I was 40 or 50 years old to have the operations done. I couldn't hold off that long, I couldn't even tie my own shoes. ... I can't wait until they improve shoulder and hand implants. I wouldn't mind being totally bionic."

Patricia Guthrie writes for the Atlanta Journal-Constitution.